GI disorders

Answer 1

anal fissure

ulcer or tear of the margin of the anus

risks:

recent or recurrent constipation; anal intercourse, recent childbirth, recent or severe diarrhea.

S/sx:

Drops of blood when wiping. NO Protracted bleeding, pain

Pain description

severe pain with BM that hurts during to hurts 1-2 hours after the BM

PE

Where is the most common location of an anal fissure?

Posterior midline - consider other diagnisis if off midline, transferse or irregular.

Treatment:

1. avoid trigger

2. lifestyle

• stool bulking agents
• high fiber diet
• periodic use of oral mineral oil (avoid long term use since this reduces the assimulation of fat soluble vitamins

3. Additional treatments after failed diet interventions

• intra anal nitro ointment
• botulinimum toxicum injected in inter and outer spincter
• surgical sphincterotomy

For discomfort:

sitz bath,

Answer 2

hemorrhoids

Description of bleed:

Bright streaks of blood on the stool; anything else should be sent for colonoscopy.

s/sx:

itch, mucus leaking, staining undergarments.

thrombosed external hemorrhoids: very painful; external; will resolve in

Treatment

weight control

topical corticosteroids

astringints

analgesics

sitz bath

use of a stool softner

fiber - 20-30 grams of fiber

surgical interventions

rubber band ligation

surgical removal

Risk factors:

prolonged sitting

receptive anal sex

chronic diarrhea

excessive alcohol use.

Grade 1:

hemorrhoids do not prolapse

Grade 2:

hemorrhoids prolapse with defecation but reduce spontaneously

Grade 3

hemorrhoids prolapst upon defaction and must be reduced manually

Grade IV

hemorrhoids are prolasped and can not be reduced manually

risk factors:

• alchohol use
• chronic diarrhea/constipation
• obestiy
• high-fat/low fiber
• prolonged sitting
• receptive partner
• loss of pelvic floor tone

Answer 3

1. acute appendicitis?

is an inflammatory disease of the vermillion form appendix caused by infection or obstruction

2. What is the peak age range?

3. S/sx:

epigastric pain, periumbilical, n/v is a late sign; pain aggravated by walking or talking; positive obturator sign, rebound tenderness. usu no fever, pain on lower right

4. what is the obdurator sign:

Flex knee to 90 with external roational causes discomfort 2/2 peritoneal irritation

5. What is the iloposas sign?

RLQ pain with extenion of R hip or with flexion of right hip against resistance.

6. What is blumberg’s sign or rebound tenderness?

release of deep palpation causes pain

7. Labs: what is expected.

8. What is neutrophila?
9. What is bandemia?
10. What neutrophil form are a marker of life threatening disease.
11. Other lab marker of inflammtion?
12. Important differential in young women?
13. What is the imaging of choice for the abd? What is a safer alternative?

14 WBC for a ruptured appendix?

15. Sign of abcess?

Answer 4

Gallstones

1. path of gallstones and most common substance?
2. What are the major risk factors?
3. What is colelithiasis?
4. S/sx of gallstone episode aka biliary colic?
5. What is collin’s sign?
6. Acute signs of cholecystitis?
7. Murphy’s sign
8. S/sx of acute cholecystitis?
9. What is preferred imaging?
10. Benefit of a HIDA scan?
11. Treatment of acute cholecystitis?

12 What are complications of cholecystitis?

Answer 5

Colorectal Ca

1. Colorectal ca is the ? leading cause of death?

2, Type and location

3. Risk factors?
4. Diet contributions?
5. s/sx of colorectal ca?
6. Most common screening test?
7. Risk factors for earlier testing?

Answer 6

diverticulosis

1. Path?
2. most common location
3. % that develop diverticulosisby 50, by 80?
4. usu presentation

5 major risk factors?

6. most common symptoms?

7 intervention for diverticulosis?

8. Diference between diverticulosis and diverticulitic
9. s/sx of acute diverticulosis
10. Imaging?
11. s/sx of diverticular hemorrahge?
12. Managment of mild diverticulitis?
    13: causative organism

14 ABX treatment of choice

15. Prevention of diverticulosis and diverticulitis?

1.

Answer 7

Peptic Ulcer Dz

1. What causes gastric irritation and ulcer formation?
2. What secretes HCl and what is the mediator?
3. What is pH of stomach acid? and purpose; other protectors
4. Purpose of endogenous prostaglandins
5. Why older adults at risk for gastric ulcurs?
6. medications implicated in gastropahty, gastritis and gastric ulcers?
7. Cox-1 mechanism r/t organ health
8. Cox-2 prostaglandin path?
9. relationship and complications of NSAIDs and systemic corticosteroids?
10. Risk of Cox-2 inhibitors?
11. other risk factors for gastric ulcer?
12. Where are ulcers found? how named?
13. gastric ulcer symptoms
14. Duodenal ulcer symptoms?
15. Which is more common and most common reason?
16. describe pathogen and route of transmission
17. What is the role of stress?
18. What is the most effective test?
19. PPI and testing?
20. H2RA and PUD; ending and names?
21. What are the concerns with use of cimetidine?
22. PPI MOA and examples?
23. Indications for PPI use
24. Problems with protracted PPI use.
25. how to manage rebound gastric hyperacidity?
26. Choosing between H2RA and PPI?
    27: use of misotprostol?

Answer 8

GERD

1. When is GERD present? What are the symptoms?
2. Cause of GERD
3. What medications can cause an increase in GERD? what is the next step?
4. What is initial therapy and examples?
5. What are the recommended behavioral changes
6. How is classic GERD diagnosed?
7. First line treatment and contraindications
8. What is the next treatment and when started?
9. When is a PPI started?
10. What are indications for gastro referral?
11. What are the GERD alarm symptoms?
12. What is the differential dx in presence of alarm findings.
13. Tips for use of PPI’s in management of GERD
14. What injury is associated with GERD and what are other complications?
15. Barretts esophagus and cancer
16. risk factors for BE
17. monitoring BE
18. Esophageal CA location and epidemiology
19. Adenocarcinoma location and epidemiology
20. Early and late symptoms of esophageal cancer
21. testing recommendations to dx esophageal ca.

Answer 9

1. How is hep A transmitted? likely outcome?
2. epidemiology in developing countries? US? Health department involvment?
3. What is the clinical presentation?
4. What is the lab presentation?
5. Hep A post-exposure prophy? sequelae, Markers for acute, chronic, past, never?
6. Hep A Onset of symptoms and incubation period
7. Hep A Who is immunized?
8. How is Hep A killed? (food, water, surfaces)
9. Details on post exposure prophylaxis. including age groups
10. Treatment of HAV infection
11. How is hep B transmitted?
12. Risk factors for infection?
13. How to kill the virus? recommended protections?
14. Sequelae of acute hepatitis?
15. Prevention and contraindication
16. sequelae of infant perinatal HBV infection?
17. who is tested for HBsAB titer?
18. How is postexposure handled for indiviuals with a completed vaccine series? not completed? never vaccinated?

9.

treatment of chronic hep B?

1. How is hep C transmitted?

2, Risk behaviors?

3. Incubation, Symptoms and diagnosis?
4. Sequalae?
5. Current treatment of Chronic hep C? other recommendations?
6. Hep D prevention and coinfection?
7. s/sx of acute viral HAV and HBV?
8. Laboratory findings common to all forms of viral hep.
9. What causes increase in AST? whar other factors increase AST? What other locations of AST?
10. AST half-life and clearing rate
11. AST and ALT in drinkers?
12. ALT half-life; clearing rate, associated conditions
13. Bilirubin levels for clinical jaundice? source of bilirubin?
14. metabolism of bilirubin
15. Excess bilirubin and viral hepatitis
16. Tx of acute viral hepatits

17 monitoring for chronic B and C

antiviral treatment for chronic HBV?

entecavir, tenofovir, lamivudine

Answer 10

1. what is the definition
2. Epidemiology
3. Diagnosis including ROME criteria
4. S/sx reported.
5. 4 typical patterns
6. What are some differentials that must be considered?
7. recommended labs and r/o
8. Recommended lifestyle and diet interventions? (common triggers)

9, Fiber for diahrrhea and constipation?

10. antispasmodics? examples and reason
11. antidiarrheal
12. osmotic laxatives;
13. TCA and related (contraindications?) REASON?
14. SNRIs (contraindications?)

Answer 11

ibd

1. etiology of IBD; dif between crohns and UC

2 Signs incommon between UC and Crohns

3. Signs of Crohns

4, serologic markers of acute IBD flares

5. Tosxic colitis
6. Associated anemias with IBD
7. extraintestinal manifestations.
8. Medication? for IBD. ABX? Chronic? Inflammation? immune modulators?
9. Several biologics:

infliximab, adalimumab (humira); lots of mabs

10. Cancer risk with UC

Answer 12

Celiac

1. most accurate seroligic markers?
2. other causes of malabsorption?

Answer 13

Pancreatitis

1. Definition
2. Risks?
3. Serologic markers?
4. Requirements for diagnosing acute pancreatitis?
5. Intervention and treatment?
6. What is Ranson Criteria?
7. s/sx? vital changes
8. Distinquishing from hepatic and biliary disorders
9. pancreatic pseudocysts def and s/sx
10. how are they found and distinquished from cancer?
11. Monitoring of psuedocyts?
12. Risk factors for pancreatic cancer
13. Diagnostic tools and associated findings.
14. LIpase and amylase evaluation

lipase elevated in?

• renal failure
• perforated duodenal ulcer
• bowel obstruction
• bowel infarction

Answer 14

Bursitis

1. Definition
2. Compare arthritis to bursitis
3. Risk factors?
4. Prepatellar first line?
5. Other site first lines
6. When to do cortisone shot? risks and SE?
7. Bursa and common presentations.